A quick and accurate way of diagnosing endometriosis

A quick and accurate test for endometriosis that does not require surgery has been developed by researchers from Australia, Jordan and Belgium, according to new research published online in Europe’s leading reproductive medicine journal Human Reproduction .

Until now there has been no way of accurately diagnosing endometriosis apart from laparoscopy – an invasive surgical procedure – and this often leads to women waiting for years in pain and discomfort before their condition is identified correctly and treated.

Now researchers at the University of Sydney and Mu’tah University in Karak, Jordan, have discovered that if they take a small sample of the endometrium (the lining of the uterus), which can be done by inserting the device for taking the biopsy via the vagina, and then test for the presence of nerve fibres in the sample, they can diagnose whether or not endometriosis is present with nearly 100% accuracy.

Endometriosis, which has been estimated to affect 10-15% of women of reproductive age, is a chronic gynaecological disease in which cells from the endometrium establish themselves outside the uterus, within a woman’s pelvic area. Symptoms associated with it include infertility, painful periods, pelvic pain and pain during sexual intercourse. Once laparoscopy has identified endometriosis as the cause of these symptoms, treatment involves surgical removal (usually via laparoscopy) of the abnormally sited endometrial cells. However, laparoscopy itself can be associated with complications and can adversely affect fertility in women who do not have endometriosis.

In a separate study also published online in Human Reproduction, another research group from Belgium and Hungary has found that the density of nerve fibres in the endometrium was about 14 times higher in women with endometriosis than in healthy women, and that using specific markers to identify the presence of nerve fibres could predict with nearly 100% accuracy the presence of minimal to mild endometriosis.

In the first study, led by Professor Ian S. Fraser, head of the Queen Elizabeth II Research Institute for Mothers and Infants at the University of Sydney and Dr Moamar Al-Jefout, assistant professor in reproductive medicine at Mu’tah University, researchers took endometrial biopsies from 99 women who had consulted doctors about pelvic pain, infertility or both and who were undergoing laparoscopy for the condition.

The results from the endometrial biopsies were compared with the results of the laparoscopies, and the researchers found that in 64 women who had endometriosis confirmed by laparoscopy, all but one tested positive for the presence of nerve fibres in the endometrial biopsy. In the 35 women who were found not to have endometriosis by laparoscopy, no nerve fibres were found in 29 of the endometrial biopsies. In the other six cases, the biopsy found there were nerve fibres present; three of these women had severely painful periods and painful sex, and also a history of infertility, and of the other three, one had adhesions that were considered too slight to be endometriosis, while the other had a previous history of endometriosis.

Women with endometriosis and painful symptoms had significantly higher nerve fibre density in comparison with women with infertility but no pain (2.3 nerve fibres per mm2 compared to 0.8 per mm2 respectively). The mean average of nerve fibre density in the women with a laparoscopic diagnosis of endometriosis was 2.7 per mm2.

The study showed that testing endometrial biopsies for the presence of nerve fibres was able to diagnose endometriosis with 83% specificity (the proportion of negative cases of endometriosis correctly identified) and 98% sensitivity (proportion of positive cases correctly identified). This double blind study confirmed the results of a pilot study published in 2007 by the same group.

Dr Al-Jefout said: “This study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis. This test is probably as accurate as assessment via laparoscopy, the current gold standard, especially as it is unclear how often endometriosis is overlooked, even by experienced gynaecologists. Endometrial biopsy is clearly less invasive than laparoscopy, and this test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management. It may be particularly helpful in cases of infertility.”

Currently, diagnosing endometriosis via laparoscopy involves the woman being booked into hospital for the surgical procedure, an anaesthetic, and the presence of doctors, nurses and expensive equipment. In some countries there are long waiting lists for operations. In contrast, taking an endometrial biopsy is relatively quick and easy to organise and perform, and results are available within about three days. However, Dr Al-Jefout said: “It needs to be emphasised that this test requires a carefully collected endometrial biopsy and an experienced immunohistochemical pathology laboratory to confirm or exclude the presence of nerve fibres.”

He continued: “Our results indicate that a negative endometrial biopsy result would miss endometriosis in only one percent of women. Performing a planned laparoscopy only on a woman with a positive endometrial biopsy result would result in endometriosis being confirmed in eighty to ninety percent of these women. Thus, using this diagnostic test in an infertility workup would significantly reduce the number of laparoscopies performed without reducing the number of women whose endometriosis is diagnosed and surgically treated.”

In addition, he said it could be particularly useful in teenagers with spasmodic symptoms but a family history of endometriosis. “The usual diagnostic delay in this special group is greater than in older women. An endometrial biopsy to confirm or exclude the diagnosis of endometriosis will help initiating earlier treatment and possibly preventing the progress of endometriosis, thus improving life style and protecting their future fertility.”

The researchers plan to continue using the test in patients and to search for other markers to help refine the test further. “Ideally, we would like to develop a blood test as an even simpler means of providing early information on the presence or absence of endometriosis in order to assist doctors in early diagnosis. However, this endometrial biopsy test has proven so effective that it is currently the only test which appears to have equivalent efficacy to a diagnostic laparoscopy carried out by an experienced gynaecologist,” he concluded.

In the second study, led by Professor Thomas D’Hooghe, coordinator of the University of Leuven Fertility Centre (Belgium), researchers looked at 40 endometrial samples, half taken from women with minimal to mild endometriosis diagnosed by laparoscopy and histology (microscopic examination of tissue), and half from women without the condition. They analysed the tissues for several markers indicating the presence of four types of nerve fibres (sensory C, A?, adrenergic and cholinergic nerve fibres).

Dr Attila Bokor, a doctoral fellow at the University of Leuven, who did the study as part of his PhD project said: “We observed nerve fibres in the endometrial samples of ninety percent (18 out of 20) of the women with endometriosis. The density varied throughout the samples, with few specimens showing counts above 30 per mm2, and with most between 0 and 10 per mm2. None, or very few, nerve fibres, were detected in any of the samples from women without endometriosis. The density of the small nerve fibres was about 14 times higher in endometrium from patients with minimal to mild endometriosis when compared with women with a normal pelvis.”

Prof D’Hooghe said: “Our data show that the combination of three different neural markers increases the sensitivity, specificity and diagnostic accuracy of this method of testing for endometriosis. The test diagnosed endometriosis with 95% sensitivity and 100% specificity.”

Dr Bokor and the team of Prof D’Hooghe will do a blinded validation study in September 2009 to confirm the results of their research. “If this confirms our findings, we believe our research can be a solid base for a simple, reliable and relatively cheap method for non-invasive diagnosis of minimal and mild endometriosis, since trans-cervical endometrium sampling and immunohistochemical analysis are routine gynaecological and pathological procedures. Our research programme is also aimed at discovering new biomarkers that can enable a blood test for endometriosis to be developed,” said Prof D’Hooghe.

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Source: eshre.com

Céline Dion Pregnant with Embryo Frozen for Eight Years

 Céline Dion, known for belting out pop songs with window-rattling power, will be fine-tuning her repertoire of lullabies with the news today that she’s pregnant with her second child.

It’s an arrival Dion mused about almost nine years ago when she was expecting her first baby, Rene-Charles.

When Rene-Charles was conceived through in vitro fertilization at a world-renowned New York clinic, Dion told interviewers at the time that a sibling was already in the works.

The pop megastar and her husband, Rene Angelil, got the good news of the latest infant on Monday after undergoing another round of fertility treatments.

“Celine is very, very happy,” Murielle Blondeau, a spokeswoman for Dion, said today when she confirmed the pregnancy.

“Celine and Rene are full of joy. It’s been a big dream for Celine to have a second child.”

Although Rene-Charles and the new baby are siblings, fertility experts say they are not twins. Identical twins are created from a single embryo that splits in the womb while fraternal twins come from different embryos that are carried at the same time.

Dr. Seang Lin Tan, a world-renowned fertility expert at the McGill University Reproductive Centre in Montreal, said there are documented cases where frozen embryos have been successfully used after two decades.

“There have been babies born who are healthy after the embryos have been frozen for 20 years,” he said.

Dion’s first pregnancy was well-documented, unlike that of fellow music megastar Shania Twain, who virtually disappeared while waiting to give birth around the same time.

The revelation that Dion was pregnant with Rene-Charles followed a jaw-dropping announcement that she would retire from performing to have a family.

She gave interviews about her pregnancy in which she chatted about how the frozen eggs might one day become a “brother or sister” to Rene-Charles, and she appeared in a series of photos showcasing her protruding belly.

Dion has said that she and her husband turned to medical science to help conceive because Angelil had been diagnosed with cancer in 1999.

After a neck tumour was removed, he was treated with radiation and chemotherapy which are known to affect fertility. Angelil’s cancer went into remission.

Dr. Zev Rosenwaks, who counselled the couple on their fertility options, told The Canadian Press in a 2000 interview that Dion had an intracytoplasmic sperm injection, in which a single sperm is injected into the egg.

Rosenwaks, who works with the Weill Cornell fertility clinic, said in the interview that Angelil had previously frozen his sperm.

The second fertilized egg was frozen five days after conception and stored at the New York clinic, Dion said in the television interview.

Tan said there is no real concern about Dion giving birth at age 41 and he noted the embryos were also frozen when she was much younger.

He said he hopes Dion’s pregnancy will draw attention to in vitro fertilization.

“Apparently when she got pregnant the first time, the popularity of in vitro in Canada went up quite a bit,” he said.

Source: thestar.com

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Culmina el primer trasplante de cara en España

 Tras quince horas y media en el quirófano, la operación del primer trasplante de cara realizado en España ha concluido esa madrugada, según ha confirmado esta mañana el doctor Pedro Cavadas, que ayer inició la intervención en el hospital La Fe de Valencia. Más de 30 personas han participado en esta operación pionera en España y la octava que se efectúa en el mundo. El receptor es un hombre de 43 años que ha recibido los tejidos faciales de otro hombre de 35 años, fallecido en un accidente de tráfico. El paciente es una de las tres personas que estaban a la espera de este tipo de trasplante. Tras el implante de rostro, cuyo proceso de extracción se desarrolló entre las 19 y las 22 horas de ayer, el paciente sigue ingresado, según informa el centro sanitario valenciano. 

Trasplante de Cara

Fuente e imagen: elpais.es

La Endoscopía Ginecológica 

Es un tipo de práctica del tipo “cirugía mínimamente invasiva”, esencialmente ginecológica, breve y de caracter ambulatorio, que se realiza tanto con fines diagnósticos como terapéuticos.

En la actualidad, en los países avanzados, se la utiliza en más del 90% de los casos, exceptuando la patología mamaria y algunos tipos de nódulos donde su aplicación aún se encuentra en discusión.
Dentro de esta especialidad, existen dos tipos de intervenciones: videolaparoscopía y la histeroscopía.

La Videolaparoscopía:

Consiste en una técnica que consiste en la introducción a través del ombligo de una óptica que, conectada a una cámara, permitirá observar las imágenes de la pelvis y del resto del abdomen previamente dilatado con anhídrido carbónico.

Es básicamente diagnóstica, pero permite que el profesional eventualmente realice el tratamiento quirúrgico, introduciendo instrumental adicional a través de pequeñas incisiones secundarias.

Se la utiliza habitualmente para diagnosticar eficientemente y corregir alteraciones que son causa de infertilidad o subfertilidad en la mujer, además de otros trastornos ginecológicos:

- Endometriosis
- Dolor pelviano crónico
- Enfermedad pelviana inflamatoria
- Abdomen agudo ginecológico
- Embarazo ectópico
- Malformaciones genitales
- Cirugías de trompas
- Miomectomías
- Cirugías de ovarios (quistes, torsiones, abscesos)
- Histerectomías
- Operación para la incontinencia de orina de esfuerzo
- Prolapsos genitales
- Adhesiolisis o liberación de adherencias
- Resección de ganglios pelvianos

La histeroscopía:

Es un método que, al igual que la videolaparoscopía sirve para el diagnóstico y tratamiento de síntomas relacionadas con la infertilidad y aspectos ginecológicos de la mujer.

Consiste en la utilización de una óptica de espesor muy pequeño que se conecta a una cámara y se introduce por el cuello del útero, permitiendo observar minuciosamente su interior, para detectar y corregir :

- Sangrados uterinos anómalos (hiperplasias, cáncer de útero)
- Adherencias y resección de tabiques
- Presencia de pólipos, fibromas, etc.
- Presencia de cuerpos extraños: DIU, etc.

Además, permite practicar pequeñas cirugías tales como:

- Biopsias dirigidas
- Miomectomías
- Polipectomías
- Resección y ablación endometrial

Las características de la endoscopía ginecológica hacen que hoy sea una práctica usual, segura y efectiva en temas relacionados con la fertilidad y la salud de la mujer:

- como método de diagnóstico, por permitir la observación directa y una máxima precisión;
- como método quirúrgico, por ser de caracter ambulatorio, ya que no requiere internación y minimiza las molestias del postoperatorio.

Para mayor información no dude en consultar de forma gratuita con nuestros especialistas Doctor Gustavo Gallardo y Doctor Andres Juarez Villanueva.

Cirugía Mínimamente Invasiva: Vesícula Biliar

¿Qué es la vesícula biliar?

La vesícula biliar tiene la función de acumular y concentrar la bilis producida por el hígado.  Habitualmente, este líquido es liberado hacia el tubo digestivo después de comer ayudando a la digestión. Dado que la vesícula concentra la bilis, en algunos pacientes la misma se cristaliza formando cálculos, pequeñas piedras compuestos principalmente de colesterol y sales biliares.  Estos cálculos pueden obstruir la salida de la bilis de la vesícula, causando su inflamación y dolor abdominal agudo, a veces acompañado de vómitos y ocasionalmente, fiebre.   Si el cálculo pasa hacia el colédoco, que es el conducto que lleva la bilis hacia el intestino, se puede producir ictericia (color amarillo en la piel) o incluso pancreatitis aguda.

¿Por qué es necesario operar la vesícula?

No existe un tratamiento médico efectivo para disolver los cálculos. Por este motivo, principalmente en los pacientes que ya han tenido síntomas lo más conveniente es extraer la vesícula, fuente de formación de los mismos.

La extracción quirúrgica de la vesícula biliar es el tratamiento más efectivo y seguro para resolver los problemas de este órgano, ya que no produce ningún daño en el proceso de la digestión.

¿Cómo se que tengo cálculos en la vesícula?

Una vez que el paciente tiene síntomas es necesario realizar análisis de sangre y una ecografía que permite al cirujano conocer el estado del hígado y de la vesícula biliar en vistas a una operación.

Tecnica Mini Invasiva

En el pasado era necesario realizar una incisión de 10 a 12 cm. para poder acceder al área de trabajo.  Esta forma de trabajar, denominada “convencional”  se acompañaba de mayor dolor postoperatorio, una internación más prolongada, y un retorno tardío a la actividad laboral.

El advenimiento de la laparoscopía, introdujo el concepto de visualizar el campo de trabajo a través de una cámara de video y trabajar a través de instrumentos delgados que se maniobran por fuera del paciente.  Así, es posible completar la  cirugía a través de cuatro incisiones de 7 a 12 mm.

¿Qué es la Cirugía Acuscópica?

Los avances en el desarrollo de la tecnología digital en imágenes y en la miniaturización de los instrumentos, permitieron desarrollar en los últimos años esta técnica innovadora que se acompaña de grandes ventajas. El nombre deriva del calibre de los instrumentos que se utilizan para operar ya que tienen un diámetro de 2 a 3 mm. y se asemejan a agujas.

Las diferencias con la laparoscopía tradicional radican en la excelente recuperación y el mínimo dolor en el postoperatorio.  El hecho de poder completar la operación con tres incisiones de 2 a 3 mm.,  hace que los pacientes puedan retornar a sus actividades habituales apenas unos días después de la operación.  La extracción de la vesícula se puede realizar utilizando una cicatriz de una cirugía previa para un mejor resultado estético.  Incluso pueden realizar actividades físicas habituales sin riesgos de complicaciones.

¿Cuáles son las condiciones para realizar esta técnica?

Las condiciones para realizar estos novedosos procedimientos se relacionan con la disponibilidad de tecnología de última generación en imágenes, instrumental apropiado, formación profesional y un centro equipado para realizar estas técnicas de manera segura.

Así es como hoy, gracias al nivel de detalle que ofrece la tecnología en imágenes, y a la disponibilidad de instrumental en miniatura, es posible realizar operaciones de vesícula biliar con alto grado de detalle, lo que otorga gran seguridad al procedimiento.

Ventajas de la Cirugía Acuscópica:

- Mínimo dolor postoperatorio
- Regreso a la actividad habitual en pocos días
- Interrupción mínima de la actividad física habitual
- Internación breve
- Excelente resultado estético

Por cualquier duda con respecto a la cirugía mini invasiva no dude en consultar a nuestro especialista el Doctor Norman Jalil.

Nacen gemelos por la combinación de dos técnicas de fertilidad

Una mujer de 39 años se ha convertido en la primera en el mundo en dar a luz a gemelos tras ser sometida al reimplante del tejido ovárico, que le fue extraído antes de iniciar el tratamiento contra el cáncer de mama para preservar su fertilidad, y combinar esta técnica con la vitrificación de ovocitos.

El alumbramiento lo han confirmado fuentes del Hospital Doctor Peset de Valencia a elmundo.es. Han indicado que los gemelos nacieron en este centro sanitario el pasado domingo en la semana 34 de gestación, se encuentran ingresados en la Unidad de Neonatos y su evolución es favorable. Sin embargo, no darán más detalles hasta que los pequeños sean dados de alta.

Este embarazo gemelar -el primero de este tipo que se produjo en España- ha sido posible gracias a la colaboración del Hospital Doctor Peset y el Instituto Valenciano de Infertilidad (IVI), que han combinado las técnicas de implante de tejido ovárico y vitrificación de ovocitos.

A la madre de los gemelos se le diagnosticó el cáncer de mama hace dos años y antes de ser sometida al tratamiento de quimioterapia le fue extraído y congelado el tejido ovárico.

Una vez que superó la enfermedad, en enero de 2008, le realizaron el implante de tejido ovárico, lo que le permitió recuperar la función hormonal y ovárica, por lo que decidió iniciar un tratamiento de fecundación in vitro en el IVI.

La mujer, que finalmente consiguió quedarse embarazada de gemelos, tuvo problemas de esterilidad previos al cáncer de mama, tenía las trompas obstruidas por una peritonitis sufrida en la infancia y tras la quimioterapia presentó un fallo ovárico precoz.

Fuente: www.elmundo.es

Para más información consulte de forma gratuita con nuestros especialistas Doctor Gustavo Gallardo y Doctor Andres Juarez Villanueva.